1. Field of the Invention
The present invention relates to surgical instruments, and more particularly relates to handle and jaw structure for an endoscopic or laparoscopic surgical instrument having reciprocating jaw members which pivot in response to the opening and closing of the handle members, where movement of the handle members is translated through an elongated tubular body member to open and close the jaw mechanism. The present invention further relates to a ratchet mechanism which is internally disposed within the handle to provide incremental positioning of the jaw members in relation to each other. The present invention further relates to novel jaw members.
2. Discussion of the Prior Art
In the prior art, various endoscopic surgical instruments are disclosed which utilize generally complex mechanisms for opening and closing handle members and jaw members to facilitate use of the device at a surgical site. Many devices provide an intricate construction in which a linkage mechanism for opening and closing the jaws requires numerous moving parts, while a sliding arrangement is provided between two extended rod members to activate the linkage mechanism in response to movement of the handle members. In addition, pivoting of the handle members in many cases causes an unwanted radial torquing force on the rod which requires additional space to be provided in the handle members to accommodate the radial movement of the rod.
Furthermore, it is often necessary for the surgeon, or an assistant, to maintain a constant force on the handles to keep the jaw mechanism closed in the event that the instrument is a grasping or gripping device such as forceps, needle holders, or retractors. This limits the surgeon's range, and in the case of an assistant, requires additional personnel to be present in the operating room, thus restricting movement in an already confining location. To alleviate this problem, it has been known to provide locking mechanisms on the handles of the surgical instruments which allow the surgeon to lock or clamp the jaw members in place to free his hands to operate additional instruments during the course of the operation. This frees the surgical assistant to support the surgeon and eliminates the need for additional assistants. Typical locking devices include arm members which extend between the handles so that a series of ridges or ribs on each arm member engage corresponding ridges on the opposite arm to lock the handles in position. Bending one arm in relation to the other releases the locking mechanism.
A disadvantage associated with these devices concerns the release of the locking mechanism for subsequent movement of the jaw members to remove or reposition the instrument. Generally, the arm members of locking mechanisms are constructed of a resilient material, such as stainless steel or rigid plastic, and the locking forces which hold the arm members in engagement are generated by the natural flexing and biasing of the material of which the arm members are constructed. To release the locking mechanism, the arms must be disengaged by overcoming the locking forces of the arms. Typically, this is accomplished by manually flexing the arms away from each other, necessitating the use of two hands, one to grasp the instrument, and the other to forcibly move the arm members. This, of course, requires the surgeon (or assistant) to cease what he is doing and release the mechanism, thus reducing the effectiveness of the surgeon during the operation, particularly in an emergency situation.
A further disadvantage lies in the fact that typical locking mechanisms cannot be overridden; that is, the mechanism is always engaged, thereby preventing free movement of the handle and jaw mechanism. This usually requires the surgeon to choose an instrument either having the locking mechanism or one that does not. This leads to an over-abundance of instruments in the operating room and tends to further complicate an already complex situation.
Finally, locking mechanisms located on the handles require special care in sterilization, packaging and storage, as well as in normal handling in the operating room. Dirt and debris may clog the ribs of the locking mechanism thus reducing its effectiveness, and damage to the ribs during storage or packaging may destroy the ribs, rendering the locking mechanism useless.
U.S. Pat. No. 1,452,373 to Gomez discloses a typical locking mechanism for a surgical instrument, in which a plurality of ribs are provided on an extension of the handle member which engage a similar rib member on the opposite handle. Once engaged, the handles must be moved away from each other perpendicular to their longitudinal axis to disengage the locking mechanism to release the jaw mechanism.
U.S. Pat. No. 4,896,661 to Bogert et at. disclose a surgical instrument having a ratchet mechanism positioned on the handle members which includes a curved rack member attached to one handle member which passes through a slot in the other handle member. A releasable pawl member is provided on the second handle to engage the rack member and provide a means for releasing the ratchet.
U.S. Pat. No. 4,935,027 to Yoon discloses a surgical instrument having a ratchet mechanism positioned between the handle members. A rack member is provided which extends from one handle and passes through a slot in the second handle to lock the handles in place. Pivoting the rack member away from corresponding grooves in the slot will release the ratchet mechanism.
U.S. Pat. No. 4,428,374 to Auburn discloses a surgical instrument having means for positioning and holding the handle members in relation to each other. A rack member is provided on one handle member which extends through a slot in the second handle member in which a releasable pawl mechanism is provided to engage and disengage the ratcheting mechanism.
With respect to jaw mechanisms and, in particular, atraumatic jaw mechanisms such as graspers and clamps, it is important for surgeons to be able to gauge or "feel" the amount of force being applied to the jaw mechanisms. This ability is particularly important in endoscopic procedures where visibility is somewhat limited and surgeons must place a greater reliance on their sense of touch. In conventional jaw mechanisms, the elements of the jaws are typically forged or cast of a rigid material into a predetermined shape. These forged or cast elements require elaborate metal working facilities and a relatively large amount of labor in finishing the elements. The finished elements usually exhibit very little flexural ability thus inhibiting the surgeon's perception of the amount of force to which the grasped or clamped tissue is exposed.
Additionally, manipulation of typical surgical instruments having jaw mechanisms creates risks to the surrounding tissue, particularly the tissue coming in contact with the distal end of the instrument where opposing jaw members meet. These risks are compounded in the endoscopic and laparoscopic environment where maneuverability of instruments as well as visibility in the entire surgical site are limited.
Furthermore, with respect to jaw members and, in particular, jaw members used for endoscopic or laparoscopic procedures where a limited number of access points to the surgical area through trocar cannulas is desired, it is necessary to keep instrumentation to a minimum. Previous devices function very well for their specific purposes, however, in conventional jaw mechanisms the gripping surface area is limited and separate instruments are required having different jaw structures for performing different functions, for example, forceps for gripping and pulling away tissue and graspers for atraumatically holding tubular vessels. Having to provide these separate instruments increases the time to perform the necessary procedures by requiring exchanging instruments in the cannulas or by creating additional access points using additional trocars.
The novel surgical instrument pursuant to the present invention obviates the disadvantages encountered in the prior art and provides a precise instrument which is easy to manufacture and efficient to use, which eliminates many of the moving parts required by prior art devices. The instrument of the present invention incorporates many features which are of use to the surgeon during an operation, including an internal ratcheting mechanism to provide for incremental movement of the tool mechanism and locking of the jaws if desired, while maintaining a lightweight construction in an easy to handle device in which all of the features may be operated with one hand. Also, the features are so positioned so as to provide a maximum line of sight for the surgeon without obstructing the view to the surgical site. Novel jaw mechanisms may also be incorporated which are easy to precisely manufacture and, in the case of atraumatic graspers or clamps, have flexural capabilities which allow surgeons to gauge the amount of force being applied. Furthermore, the jaw mechanisms may have novel multiple tissue handling portions which add gripping surface while keeping risks to surrounding tissue low and allow surgeons to use fewer instruments, therefore, reducing the time required to perform procedures.